Note from John Pagano FAB Strategies: I received this guest blog story from Constance Ray. She tells Shawn’s story of how he is courageously living each day to overcome childhood trauma and addiction, and prevent it’s legacy in his own family. May of the teens I work with show the same courage in facing family trauma and addiction. You can e-mail Constance and find out more about her work at email@example.com Photo By: Pixabay
Shawn’s Journey to the Top: How He Overcame an Abusive Childhood and Addiction
When we picture addiction, the image that often comes to mind is that of an adult. However, what many people don’t realize is that childhood experiences often set the stage for potential addictive behaviors later on in life. Once it has its iron hold, it can seem impossible to get out. We talked with one addiction survivor about how he not only broke free from his dark past, but found it in his heart to forgive.
Shawn’s story begins when he was just a young teenager. While other boys his age were learning life skills from their fathers, Shawn did his best to avoid his father and the accompanying pain.
“I grew up in an extremely abusive household. I was abused mentally, physically, and emotionally by my dad. I started using cocaine to numb the pain. I didn’t use it everyday, but I used it often and I used it on and off for about 20 years,” Shawn said.
Fast-forward several years later, and Shawn found himself moving to Rhode Island after a failed marriage, leaving behind a son. He remarried, but the drug use followed, sending him spiraling into depression.
“One day, my wife had enough of what I was doing and tossed me out on the street. My so-called ‘friends’ at the time all backed out and were nowhere to be found,” Shawn said. “I had nowhere to go and nowhere to stay, and so I was homeless.”
Shawn was left with nothing but a motorcycle to his name, but even that failed him.
“I’ve been riding a motorcycle for nearly 40 years and never had a wreck, but one day I left the kickstand out and wrecked my bike, breaking four ribs in the process,” Shawn explained. “I was without a job, without a home, without my wife, and I was in a lot of pain. And that’s when I felt like God said to me that it was time to get my life together.”
Looking up addiction rehabs on his phone, it just so happened that the first one he came across was the Treehouse in Texas. Not able to afford the trip, Shawn’s family chipped in, much to his disbelief.
“Most surprisingly, my son helped to pay for my plane ticket, which made me feel both good and bad about where my addiction had taken me,” Shawn said.
Shawn credits the kind and caring staff for helping him put an end to his drug use and move forward from his painful childhood.
“I learned to forgive; I forgave my dad and let go of that anger and pain. I forgave myself for all of the hurting that I caused myself and my family. I really had a spiritual awakening at the Treehouse. When I surrendered to God, I felt like I was 1,000 pounds lighter, because He took all of that from me,” Shawn said.
As for his family, Shawn said they are continuing to heal each and every day, crediting his wife for saving him from a life of drug abuse and sadness.
“I’m still working to try to patch things up with my wife. I know that the day she put me out of the house is what saved my life … I know everything happened this way for a reason, and I am going to do everything I can to make it work with us. I’m also working towards reconnecting with my son,” Shawn said.
Addiction was Shawn’s way of coping with the pain his father caused him, but he realizes now that ultimately, everything he did was self-inflicted as a way to dull the pain.
“I was so used to being put down and was never good enough for my father, but now I truly know that I have a purpose in life: to help others and to enjoy life as it comes — through good and bad,” Shawn said.
No matter how difficult your past has been, drugs are never the answer. Facing it is scary, but you aren’t in this alone. Like Shawn, you can break free from whatever has caused you such immense pain, beat your addiction, and find your life’s purpose.
Over half of students with Autism Spectrum Disorders have sensory over-responsivity to tactile and auditory stimulation with reduced sensory limbic habituation (Green et al., 2015). Their lack of habituation makes it physiologically more likely they will become distracted and have difficulty learning. Significant sensory modulation difficulties were related to attention and academic achievement challenges in children with Autism Spectrum Disorders. Students with Autism Spectrum Disorders and significant sensory modulation difficulties benefit from learning to use coping strategies that improve their attention, learning and behavior in the classroom. Among SBIs (sensory-based interventions) tactile massage intervention a minimum of 15 minutes, twice weekly for 3 months has the greatest research support for improving student behavior and learning (Wan Yunus et al., 2015).
Sensory coping strategies for students with Autism Spectrum Disorders who have sensory over-responsivity begin with teaching students to monitor their energy levels to determine if they are high, medium or low and whether their energy levels are OK for learning.
Next, evidence-based environmental adaptations should be tried to minimize auditory (sound absorbing walls, noise canceling headphones, carpeting), visual (halogen lighting, study carols), and tactile distractions (specific seating so they will not accidentally touch peers). Finally, teachers and therapists should try to reduce the pace and volume as well as increase the salience of instructions, and use visual supports as indicated (Ashburner et al., 2008; Kinnealey et al., 2012). Breaks from learning involving deep pressure and linear movement (Murray et al., 2009), such as by having the student pass out books or deliver messages, can also promote learning. Given that over half of students with Autism Spectrum Disorders also demonstrate significant sensory over-responsivity, it is important to teach coping strategies that will maximize their learning. speechaudnevhandouts ERI2017SBISupplement
Ashburner, J., Ziviani, J., & Rodger, S. (2008). Sensory processing and classroom emotional, behavioral, and educational outcomes in children with autism spectrum disorder. American Journal of Occupational Therapy, 62, 564–573.
Green, S. A., Hernandez, L., Tottenham, N., Krasileva, K., Bookheimer, S. Y., & Dapretto, M. (2015). Neurobiology of sensory overresponsivity in youth with autism spectrum disorders. JAMA psychiatry, 72(8), 778-786.
Kinnealey, M., Pfeiffer, B., Miller, J., Roan, C., Shoener, R., & Ellner, M. L. (2012). Effect of classroom modification on attention and engagement of students with autism or dyspraxia. American Journal of Occupational Therapy, 66, 511–519.
Murray, M., Baker, P. H., Murray-Slutsky, C., & Paris, B. (2009). Strategies for supporting the sensory-based learner. Preventing School Failure: Alternative Education for Children and Youth, 53(4), 245-252.
Wan-Yunus, F. W., Liu, K. P., Bissett, M., & Penkala, S. (2015). Sensory-based intervention for children with behavioral problems: a systematic review. Journal of autism and developmental disorders, 45(11), 3565-3579.
Many children with behavioral, developmental and sensory challenges have difficulty maintaining a quiet alert state for learning. These children tend to be low registration (miss important sensory input) and/or sensory sensitive (overly responsive to functionally irrelevant sensory input) the majority of the time. The Sensory Profile is a reliable, valid assessment that can be used to determine if children have significantly different sensory modulation. It is important to help children with significantly different sensory modulation to learn to monitor and regulate their arousal levels and maintain a quiet alert state for learning. Colors can help children understand their sensory modulation level by using Blue to designate hypo-responsive, green an optimal quiet alert state for learning, yellow a hyper-responsive, and red an extreme hyper-responsive state.connotapres2017handout
A visual support integrating colors, energy levels, and sensory modulation can help children learn to identify and modulate their arousal levels. Children are encouraged to work with the teacher or therapist to identify their common feelings and actions when experiencing various energy levels.
A simpler alternative is to make a High, Low and Medium Energy visual, and have children identify their arousal level and whether their current energy level feels O.K. or not O.K and why. Some children learn better using the visual supports shown above, while others do better without it through only adult modeling. without it can be used to teach children to modulate their arousal levels. For example, the therapist might model by saying, “I am high energy and feel not OK, because I’m too hyper to be a good teacher. My heart is beating really fast, I’m breathing fast, my hands are shaking, my arms feel tight like raw spaghetti, and I’m talking fast and loud. I’m going to do 10 pushups to lower my energy level”.
For some children high energy is their only problem, while others experience low energy as well. For low energy children I model “I’m low energy and feel not OK because I don’t have enough energy to be an exciting teacher. My heart rate and breathing feel slow, my arms are soft like over-cooked spaghetti, and I’m talking slowly and soft. I feel sad and dead inside. I’m going to do do 10 fast jumping jacks to increase my energy level”.
As children develop, yellow can be added to designate a slightly hyper-alert state that precedes the red hyper-arousal state in which they misbehave. This is helpful because early recognition of high energy is easier to control. They can also be encouraged to use colors to relate their most frequent arousal level accompanying their feelings. The student who constructed the feeling wheel shown below depicted sad and lonely as low energy; embarrassed as high energy; and frustrated & mad as very high energy. In addition, happy & nervous were depicted as related to both average energy and high energy states.
A general FAB Strategy for helping all students modulate their energy levels is to first decrease, then if needed gradually increase sensory input. This is depicted below using a visual support that shows a student who frequently fluctuates between a low energy and high energy state, with only a small window of quiet alert functioning. In a classroom the teachers response would involve first lowering the noise level and visual distractions for a dysfunctional high energy or low energy student. This alone will often enable students to achieve a quiet alert state. If they are still not in a quiet alert state, give graded input from the lowered sensory level in a predictable, socially acceptable way until a quiet alert state is reached.
Once the therapist is able to vary environmental input to enable a student to reliably achieve a quiet alert state, they can help the teachers, parents and student to do this independently.
Therapists and teachers can expand their understanding of arousal levels by synthesizing theories of the Autonomic Nervous System, sensory modulation, influences of early childhood PTSD, and Bipolar Disorder to expand their understanding of arousal level challenges. The focus is on helping children notice when they first enter the blue or yellow zones, so they can find ways to increase or decrease their arousal levels as needed.
Students can use colors through visual supports, modeling, and/or using the smells of the scented color markers to learn if they are in the blue, green, yellow or red arousal zone. This understanding provides a foundation for developing individualized coping strategies to manage their arousal levels.
Sensory-based intervention (SBI) groups can be useful in schools and clinical settings to improve sensory skills, behavior and learning. SBIs are the guided use of sensory strategies to improve behavior by addressing specific sensory modulation or sensory discrimination challenges. SBIs are commonly implemented in early intervention, school, and mental health settings through individual, group and consultative interventions. SBIs include directing other professionals in embedding goal-directed sensory activities into a student’s daily routine to improve behavior for learning.
It is important to distinguish occupational therapy utilizing SBIs from Sensory Integration Intervention. While SBIs and Sensory Integration both utilize the theory of sensory integration, they are distinct interventions with unique research efficacy. Sensory integration intervention, also referred to as Ayres Sensory Integration® is a developmental clinic-based, child-led intervention that follows specific core concepts.
SBIs can empower clients to actively substitute the sensory input provided through aggressive, inappropriate and self-injurious behavior with sensory coping strategies and adaptive equipment. SBIs are goal-directed and specifically matched to the client’s needs and preferences. The use of SBIs has been integrated into the evidence-based Greenspan Floortime Approach for Autism Spectrum Disorders, Collaborative Problem Solving Approach for children with oppositional defiant disorder, Dialectical Behavioral Therapy for adolescents with borderline personality disorder, and models for reducing restraint and seclusion in mental health facilities and schools a-reducing-restraint-and-seclusion OTPractSchoolOTRedAgg .
The new ESSA “Every Student Succeeds Acts” (2015) potentially expands the role of school therapists in helping at risk students and consulting with parents and teachers to improve school climate. Under ESSA occupational, physical, speech/language, and school mental health therapists are designated as Specialized Instructional School Personnel (SISP) and given a role in helping at-risk regular education as well as special education students. SBI’s can be included in interventions to educate students, staff and parents in enhancing student self-regulation school therapist consultations and group leadership.
Effectively using sensory-based interventions (SBIs) to improve functional behavior is different from the more common practice of randomly distributing adaptive equipment or using a single sensory strategy such as brushing for every student in a class. Using SBI adaptive equipment and sensory strategies to optimally promote functional behavior begins with an occupational therapy assessment, developing an individualized functional behavioral goal, gathering baseline data on the goal, and matching the client with the most appropriate individualized environmental adaptation. Once a specific environmental adaptation has been implemented consistently for a month in conjunction with other professionals, it’s effectiveness is assessed to determine if the environmental adaptation should be continued, modified, or discontinued.
Sensory modulation is the ability to respond to functionally relevant sensory information while screening out irrelevant input. Simply helping students understand their sensory modulation and/or sensory discrimination differences is an important first step in SBI. Therapists can begin by discussing sensory modulation “energy levels” as low, medium and high, to help students identify when their energy levels are too high or low for behaving appropriately and learning. Consistently using the color codes developed by the Zones of Regulation program can be part of the effort in helping students gain a better understanding of how their arousal levels affect their behavior and emotional regulation.
Once students have modulated their energy level, consider and intervene if sensory discrimination disorders are negatively impacting behavior. When in the quiet alert state some students can still become dysregulated because of sensory discrimination disorders in which they have difficulty distinguishing, interpreting and organizing the information coming in from all their various senses. For example, sensory discrimination disorder can involve problems organizing and combining information from the pressure, touch, and movement senses to appropriately print the “b”.
Sensory discrimination disorder can occur in any combination of ones sensory systems: tactile (touch), proprioceptive (muscle force/tension), interoceptive (internal organ states such as hung & pain), olfactory (smell), gustatory (taste), auditory, and visual. it is most widely described in tactile discrimination disorder. A common assessment item regarding tactile discrimination from the Miller Assessment for Preschoolers involves the therapist having a client identify which finger is touched with eyes closed, with consistently accurate identification expected by age 3. Some high school students who are above grade level who had a trauma history and psychiatric disorder were inconsistently able to do this task. This difficulty alerts me to the need of increasing body awareness. Sensory Discrimination Disorders can involve the sense of: touch, proprioception (body awareness), vestibular (movement), vision, sound, taste, and/or smell. Interventions of sensory discrimination disorder are best done after basic sensory modulation has been addressed.
Recent research suggests that interoception can be a significant component of sensory discrimination disorders. Interoception challenges involve confusion regarding internal body sensations such as hunger, thirst, and pain. Exploring internal sensations through sensory mindfulness activities can help address interoception. Research supports that mindfulness activities can be helpful interventions for individuals with somatic pain and post-traumatic stress disorder challenges.
Sensory discrimination disorder contributes to difficulties with body awareness, embodiment, and organizational skills. Sensory discrimination disorder is more commonly seen in clients who experience early childhood post-traumatic stress disorder. It is hard to teach self-esteem and respecting others personal boundaries when clients don’t have adequate body awareness.
It is important to help students learn to identify what they are feeling before they yell, hitting others or engage in problematic behavior “because they suddenly feel horrible”. For students with developmental challenges it can be helpful to combine feeling faces with the color codes from the Zones of Regulation so they can use pictures to identify their negative feelings and arousal level and get assistance with finding self-regulation activities.
SBI involves the use of individualized adaptive equipment to improve specific goal-directed behavior, such as reducing noise and visual distractions with a study carol and noise-canceling headphones to reduce peer conflicts and increase attention. It can also include massage, mindfulness activities, or embedded classroom tasks involving delivering a box of books for the teacher as a deep pressure movement break. The most important and often neglected step is to identify and educate students regarding their specific sensory challenges related to behavior, and to reinforce all efforts to self-regulate.
school-therapy SUPPLEMENTAL Therapy in the Schools Slides
“Functionally Alert Behavior” FAB Strategies® is an evidence-based curriculum of environmental adaptation, sensory modulation, positive behavioral support, and physical self-regulation strategies for improving the functional behavior of children, adolescents and young adults with complex behavioral challenges FAB Strategies ERIC document Complex behavioral challenges involve a combination of inter-related mental health, developmental, sensory and environmental challenges. The FAB Strategies® curriculum is individualized by occupational, physical, speech and mental health therapists for coordinated use in conjunction with the client, their family and teachers. The FAB Strategies®curriculum emphasizes the use of a coordinated multidisciplinary approach that addresses specific goal-directed functional behaviors in the natural environment.
FAB Strategies® is useful for guiding integrated individual, group, and home program intervention by teachers, family members, as well as occupational, physical, speech and mental health therapists. Teachers, therapists and familys face the challenge of helping students develop the behavioral skills that support learning. This challenge has become more difficult given the increasing academic demands and numbers of students with complex behavioral challenges. It is crucial to help students with complex behavioral challenges because their behaviors interfere with these students’ and their classmates learning. The “Functionally Alert Behavior” FAB Strategies® curriculum can improve self-control in students with complex behavioral challenges.
The FAB Strategies Form guides therapists in developing an individualized program for improving the client’s functional behavior fab-stratform Section A environmental adaptations provide the structural foundation for FAB Strategies. The child’s response related to his functional goal guides the use of environmental adaptations. Environmental adaptations include adaptive equipment such as fidgets, visual schedules and adaptive techniques.
Environmental enrichment through adaptive equipment, visual schedules, and adaptive techniques reduces aggression in children with behavioral challenges and developmental disabilities. When developing environmental adaptations, it is important to consider the dynamic relationship between the child’s behavioral, sensory, cognitive, and environmental challenges. Environmental structure and behavioral demands are interacting variables, with greater sensory demands suggesting the need for more structure. When children show improved self-control or demands are decreased, structure is reduced to promote independence.
Section B sensory modulation strategies help lower stress and enhance self-regulation, with the massage activities included in this section. Sensory modulation includes body awareness, basic mindfulness, touch, and motor self-control strategies. The Pagano FAB Trigger & Coping forms use pictures visually representing common environmental and body triggers as well as sensory coping strategies for children with behavioral, developmental, and sensory challenges.
Section C positive behavioral control strategies improve behavior and communication skills. Learning social and communication skills significantly improves the behavior of children with developmental and behavioral challenges. Functional communication can be supported and rewarded through socially embedded reinforcers. For example, when a child says or signs “jump”, the therapist takes the child’s hands and jumps with the child. Section C also includes the FAB Turtle Technique, where a child notices his triggers and does his individualized self-calming strategies in the sensory coping area.
Section D physical sensory strategies promote attention, behavior, and social skills through cardiovascular, dynamic balance, sensory motor, and sequential bilateral tasks. Children with developmental challenges are motivated to participate in sensory activities, making them an effective means for promoting behavioral change. FAB Strategies attend to a child’s arousal level so he can play without becoming overly excited. For example, if a child rates his energy level as “uncomfortably high” following play ground tasks he is assisted in calming down before returning to class.
“Functionally Alert Behavior” FAB Strategies® offers an evidence-based curriculum of environmental adaptation, sensory modulation, positive behavioral support, and physical self-regulation strategies for improving the functional behavior of children, adolescents and young adults with complex behavioral challenges. Application of the FAB Strategies®curriculum emphasizes ta coordinated multidisciplinary approach that addresses specific goal-directed functional behaviors in the natural environment.
Occupational therapists use sensory-based interventions (SBIs) to improve the behavior of children, adolescents and adults with developmental and sensory processing challenges. SBIs are the guided use of sensory coping strategies and adaptive equipment to improve sensory modulation skills and behavior. Emerging evidence suggests that SBIs can significantly reduce distress and promote attention.
SBIs empower clients to actively substitute the sensory input provided through aggressive and self-injurious behavior with sensory coping strategies and adaptive equipment. However, SBI intervention needs to be goal-directed and specifically matched to the client’s needs and preferences. The use of SBIs has been included in the research supported Greenspan Floortime Approach for children with Autism Spectrum Disorders, Collaborative & Proactive Solutions Approach for children and adolescents with Oppositional Defiant Disorder, and treatment models for reducing restraint and seclusion in pediatric and adult mental health facilities as well as schools OTPractSchoolOTRedAgg Reducing-Restraint-and-Seclusion Continue reading
I developed FAB Strategies (Functionally Alert Behavior Strategies) to help children, adolescents and young adults who have complex behavioral challenges. The FAB Strategies Form guides the use of environmental adaptation, sensory modulation, positive behavioral support, and physical self-regulation strategies. The FAB Strategies forms enable teachers, families as well as occupational, physical, speech/language and mental health therapists to work towards the same functional behavioral goals using consistent strategies. The copyrighted FAB strategies forms are offered free of charge to therapists for use in developing home programs that improve functional behavior.
FAB Strategies combines positive behavioral support and sensory processing strategies to improve behavior. School occupational therapists can effectively team with parents and school staff to reduce school aggression, restraint and seclusion.